Hurricane Maria: Impact on Puerto Rico

Introduction
Hurricane Maria slammed into Puerto Rico in September 2017, just two weeks of Hurricane Irma had passed through. The Category 5 Maria was bad enough—but the fact that it came on the heels of Irma, also a Category 5 storm made it all the more devastating. Puerto Rico had not even had time to recover from Irma, which had set it up against the ropes, when Maria entered and put the island territory into dire straits. This paper will discuss the impact of Maria on the Puerto Rico population, what aid and response was delivered in support of the community, the strengths and deficiencies of the cultural competency of the response, and what recommendations as a program manager could be made to enhance cultural competency.
Impact on Populations
Puerto Rico’s population was already in poor condition prior to Maria making landfall. Irma still had some 100,000 people without power when Maria hit, and the territory was deeply in debt and without many prospects of climbing out of that debt as new tax policies had been adopted that had caused many large corporations to flee (Baker & Dickerson, 2017; Sullivan & Feiser, 2017). When Maria struck, the hurricane destroyed what was left of infrastructure.
Maria completely obliterated the power grid of Puerto Rico, putting everyone out of power—except for hospitals with backup generators. Communications were gone, except for a handful of radio towers, which were almost impossible to reach because of flooding. Local leaders let the population know they may be without electricity for up to half a year. Energy was the least of problems, however. Locals were left without shelter, without food, without medicine and without clean water. In the aftermath of the hurricane, Puerto Ricans suffered significantly without any assurance that their most basic needs for survival would be met (De Arzola, 2018). Disease ran rampant through the population: people contracted pneumonia and emphysema. The most affected population was the elderly population. The elderly were hit by a wave of hopelessness and many of them took their own lives following stories that no water would be coming (Varney & Kane, 2018). The elderly population was the most vulnerable because they had no news but locally spread rumors, and since everyone was basically cut off from everyone else, they were vulnerable to fear and despair. Puerto Rico had already been plunged into poverty beforehand, so it was not as if there was anything for this population to fall back on.
The health care sector had planned in advance so as to be ready for these types of situations. Health care populations were trained on what to do and their training came into effect. The Public Health Emergency Preparedness Cooperative Agreement (PHEP) Program was in close communication with the CDC of the US. FEMA also had a presence in Puerto Rico. The health care population was the most prepared of any of the groups in Puerto Rico. It was the poor and the aged who suffered most because they had no one and nothing to look out for them.
Aid and Response in Support of Community
The Southwestern Regional Academic Medical Center had been set up in 2006, a decade prior to the hurricane, for the purpose of responding to hurricanes and other disasters. It now sprang into action to provide health support for those in need. Generators were in place to keep facilities going so that people could be treated with all the conveniences of modern medicine. The US sent the National Guard, and FEMA also joined in to help. The CDC collaborated with PHEP to get medicines and vaccines to people who were vulnerable to sickness. Because of flooding and food shortages and sanitation problems, diseases were feared and vaccines were distributed to prevent the risk of widespread outbreaks.
One of the most important needs of the Puerto Rico community, however, was the need to clear roads and get infrastructure restored. The Army Corps of Engineers was brought in to do this. Crops had been destroyed. Homes had been leveled. Shelters had to be installed. Flooding had to be dealt with. Getting electricity grids back up and running was important. But it would be a sometime before any of this happened, and emergency shelters would become permanent. Half the population continued to be without fresh water for months afterwards (De Arzola, 2018).
Or than focusing on infrastructure and medicine, the other key aspect to recovery and response was getting food, water and other supplies to the population quickly. Unfortunately, there was an outdated piece of legislation on the books in the US called the Jones Act that prevented ships from leaving American ports for the territory unless those ships were flying the US flag. This meant that even though there were many cargo vessels that could have quickly delivered supplies they were lawfully banned from doing so. It took a special request from Puerto Rico to ask the US to set aside the Jones Act for the occasion of this significant emergency. Nonetheless, it was a substantial delay that put many people at risk (McMahon, 2018).
The issue of corruption also plagued the recovery. The US was a big contributor in assistance, but US officials accused Puerto Rican officials of wasting money or losing valuable resources. Puerto Rico’s leaders had failed to have a protocol in place for dealing with such an emergency. Meanwhile, Puerto Rico accused the US of corruption, particularly when a large government contract was awarded to a small company that had never dealt with this kind of recovery before—and it turned out that the company was from the home state of the Secretary of the Interior, which raised questions of conflict of interest (Klippenstein, 2017).
Overall, the response was a mixed bag; in some areas, such as getting vaccines and health care to people in need, Puerto Rico was somewhat prepared thanks to organizations that had planned years in advance for this type of situation. However, in other areas, Puerto Rico was not prepared at all. It had already devastated the economy by changing its tax laws and chasing big investment from the territory. People were destitute and the elderly population was exceedingly vulnerable. Suicide cases rose exponentially following the hurricane, and Puerto Rico’s leaders were not in a good position to calm the fears of the people. They would put out false public announcements about a certain village only to have the villages come forward and declare them a lie. Public officials were trying to calm fears by saying that power was being restored to certain areas for example and the people living in those areas were vocal that they were still without power. All of this served to erode morale and destroy trust in the public officials and their messaging.
Cultural Competency in Response
Strengths
The strengths in the cultural competency response to Hurricane Maria in Puerto Rico was that programs and organizations like PHEP and the CDC were prepared in advance to get medicine and vaccinations to all populations as soon as possible. Much of the territory had been impoverished already over the years, so nearly everyone was in the same socioeconomic boat. There was little that anyone could do in terms of work; survival mode was the order of the day. The health care facilities with generators were able to administer to pregnant women, treat the wounded, and get vaccines to the sick and vulnerable.
However, many elderly members of villages were not assisted as much as was needed; they despaired and took their own lives rather than wait without hope. The situation was bad all the way around—there was no power, no food, no shelter, and no water. It took a strong spirit to keep one going as support networks were also destroyed along with communications. Emergency shelters and shipments of food and water were provided but only those who were able to move quickly and get to places where support was offered were able to benefit. The elderly population was not really in any position to take advantage of these services.
Deficiencies
Communication, messaging and planning were abysmal. There was little competency demonstrated with regard to helping vulnerable populations other than via health care facilities. There was no system in place for providing support for the elderly. It was essentially a first come, first serve type of solution that was implemented. Then the slowness of the recovery further aggravated the situation. The population overall was sorely dependent upon foreign assistance, and here the trouble was that the assistance was questionable.
First of all, the collaboration between local leaders and the US leaders was poor; there should have been a protocol in place for dealing with emergency situations like this—but there was not. Many Puerto Ricans were left without aid because their leaders, who had been making promises for years about providing a protocol had failed to deliver anything of substance. There was nothing for anyone to do except wait and try to survive as best they could while the US Army Corps of Engineers tried to get infrastructure back up and running.
Recommendations as a Program Manager to Enhance Cultural Competency
A decentralized approach to enhancing the cultural competency of response in an emergency situation like this would have helped immensely. As it was, the locals were left relying on inadequate leaders more concerned with their own image and finding a scapegoat to blame than on actually helping. Charity groups such as Catholic charity organizations and other non-government organizations were of great assistance during this time. There should have been more interaction and coordination with these types of groups, as in the past volunteers working with these groups have been very effective in delivering care and getting aid to people. They have been through these experiences multiple times and they dedicate their lives to helping out. They know what is needed, how to deliver, and they work within a decentralized paradigm that allows them to respond to the needs of the present situation without dealing with any type of bureaucratic overhang.
Contracting with non-profit groups from local regions would also help to reduce some of the widespread corruption that occurred. Whenever there is a major disaster like this there are opportunists seeking to profit somehow. However, if governments simply contract with pre-existing non-profit groups that already have the means and skills and tools for delivering aid, it reduces the risk of outsider groups stepping in to steal funds and exploit the disaster.
Pre-planning is also an essential element that often gets overlooked in this type of disaster situation. It is not difficult to plan ahead, to foresee based on past experiences, what type of cultural competence will be needed in the next disaster situation. Clearly, the most vulnerable populations—like the elderly and the impoverished are at the most risk. There has to be some kind of protocol developed in advance to reduce the risk of suicide and despair. This can be as simple as putting out sustainable social systems that can keep people connected in the event that the power grid is destroyed.
Community leaders have to be developed, however, so that they can step in when political leaders fail to come through. Political leaders are certainly not to be relied upon because they are often focused on their own careers, their own image, and their own interests. Community leaders, on the other hand, tend to be invested in their communities and committed to safeguarding and helping their populations. They have an interest not in themselves but in their people, and they are the ones with the reputation of getting things done and keeping people together. They should be tapped as an integral force and source of support.
Reform should also be advocated as people come together to address the situation. Even after Maria struck, people in Puerto Rico were wondering what their political leaders would do to better prepare everyone for a future situation. Political leaders even still were hemming and hawing about policies and plans. Nothing was finalized and the can was essentially kicked down the road. Reform is needed in government to keep these kind of individuals from running away with political funds. They should be held accountable in the most severe way.
The key to it all will be creating a decentralized system in which local groups and agencies, local community leaders, non-government organizations, trained professionals and foreign aid services can work together in a meaningful way to make sure that the most vulnerable populations are supported in a time of crisis like that which descended on Puerto Rico after Maria struck in 2017. Such a decentralized system depends entirely upon communication and understanding the needs of the local and vulnerable populations. This means coordinating with and contacting people on the ground, working closely with church leaders and community leaders so that there is a sense of what the needs of different people and groups are and how those needs can best be satisfied. Unless this is approached in grassroots way, in a bottom-up manner, the success of the initiative will be lacking.
Conclusion
The need for people to understand how they can help in a time of crisis is based upon an assessment of who is vulnerable. The vulnerable populations of Puerto Rico were the impoverished and the elderly. They had little to no support system in place and no way of getting aid. Suicide rates soared as a result. There were agencies involved that provided medicine and vaccines, shelter and food and water wherever they could. But this was a limited approach. More needed to be done at the local levels, with local community leaders paving the way forward. Instead of relying on government officials with poor track records, the territory needs to have a decentralized network of support in place.
References
Baker, P. & Dickerson, C. (2017). Trump Warns Storm-Ravaged Puerto Rico That Aid Won’t Last ‘Forever’. Retrieved from https://www.nytimes.com/2017/10/12/us/politics/trump-warns-puerto-rico-weeks-after-storms-federal-help-cannot-stay-forever.html
De Arzola, O. R. (2018). Emergency Preparedness and Hurricane Maria: The Experience of a Regional Academic Medical Center in Southwest Puerto Rico. Journal of Graduate Medical Education,10(4), 477-480.
Klippenstein, K. (2017). $300M Puerto Rico Recovery Contract Awarded to Tiny Utility Company Linked to Major Trump Donor. Retrieved from https://www.thedailybeast.com/dollar300m-puerto-rico-recovery-contract-awarded-to-tiny-utility-company-linked-to-major-trump-donor
McMahon, C. (2018). Double down on the Jones Act? Journal of Maritime Law & Commerce, 49(2), 153-195.
Sullivan, B. & Feiser, E. (2017). Maria Latest Threat to Puerto Rico After $1 Billion Irma Hit. Retrieved from https://www.bloomberg.com/news/articles/2017-09-19/hurricane-maria-heads-for-puerto-rico-after-dominica-strike
Varney, S. & Kane, J. (2018). Amid new hurricane season, Maria still taking a toll on Puerto Rico’s elderly. Retrieved from https://www.pbs.org/newshour/show/amid-new-hurricane-season-maria-still-taking-a-toll-on-puerto-ricos-elderly